arks

Hey Guys! Thank you for your support! I did it! I finally got my band!

Surgery went well, Dr Waggoner is awesome, he also corrected a hernia while he was there by the way. I didn't have pain on the incisions, but gas pain that was (is) killing me! I am still at the hospital since I am still unable to pass gas. I have walked, walked walked, sipped liquids every 15 minutes, and still those stubborn gasses are stuck! I will be discharged later today though. I will keep you guys posted!

I am getting banded tomorrow too! I am nervous, but I can't wait to start my journey post op. Good Luck, and see you on the other side! *hugs*

Well, tomorrow is the big day, FINALLY! I have been on a liquid diet for 5 days and I feel like eating my arm off! I have lost 8 pounds total before surgery, and I can't wait until I reach my goal! For now, I just have to say, I am getting banded tomorrow at 8:30am, North Cypress Hospital, by Dr. Waggoner.

Please pray for me and See you on the other side!

Ark

How was your surgery?? How do you feel!?

CONGRATULATIONS ARKS...... I know you must be excited. I am scheduled to be banded on the 28th but I don't think its really hit me yet that its really going to happen. One thing that kept going through my mind over the holidays was this is the last year I will be fat in our family pics.... next Christmas is going to be the best one ever as far as i am concerned. Let us know how it goes for you....

Thank you BlairE! and yes, the same thought has been passing through my mind! I am actually looking forward to Summer, and to actually BE A PART of my family photos, This is going to be the year for all of us! Good luck to you too and congrats!

Thank you guys!

How 'bout a new topic for January Bandsters. New Years-New You!

I'm being banded Jan 12th at UCI in Orange, California. How about you?

I'm going to be banded on the 12th too! North Cypress Hospital; Houston, Texas!

I was approved today! I will be banded on the 12th so I might not be able to go to this meeting BUT I do want to meet with you guys! so, I'll send my email on a private message so you can send me the questionnaire!

I got the call today, I was APPROVED! after all these months, after doing one thing after the other, after hanging in there without losing hope, my surgery date is going to be on Wednesday, January 12th! I am excited and scared, it's like reality finally hit me. I was rushing through the seminar and surgeon visits, then the 3 months diet, then all the exams, getting everything ready for Tricare, getting the clearance from my PCP, then the paperwork sent to insurance (2 nerve wrecking days!) then the call... Now it's just 5days on a liquid diet and I'm done. I'm getting banded... I really don't know if I should laugh or cry, I definitely feel like doing both!

I was approved today, getting banded on Jan 12th!

When I went to my first surgeon app he told me that I needed to lose 10 pounds before surgery. He also told me that I am headed to weight loss, so why not start losing right away.

Even if I am not told about having the liquid diet I think I'll do it anyways, at least for a week. You'll lose weight, reduce your liver size a bit and get your body on full mode on for what your post op liquid diet would be.

Have anyone tried Shakeology for the Pre Op liquid diet? I love Shakeology but I don't know if I should take that or the one my doctor tells me. I am not at that stage yet, hopefully would be there soon! (I can't believe I am actually looking forward to not eating!).

So, What Protein Shakes are the best in your opinion?

Hi, I was kind of in the same situation. I have 100 lbs to lose and I am only 26. My doctor said the Vertical Sleeve would be better but Tricare doesn't cover it. He said that There's a point when the lapbanders get "stuck" and stop losing weight as they used to lose in the beginning. I don't know if that's true or not. He also said Gastric bypass could be a better option than the band but I have met a few people that after losing ALL the extra weight, they gained it back, and that scares me! So I politely said no and that my only interest was the band. Because, worse case scenario, if something goes wrong at least they can remove the band and that's it. Taking a portion of your stomach or "re-tubing" it it's more invasive and there's more room for a mistake and if in the future you want it reverse, you can't.

It's a personal choice, do your research and do whatever you think will be better for yourself. Doctors are wrong sometimes, your inner voice is never wrong

Oh I can relate! you know, I was really thin once. I was merely 108lbs. that was 5 years ago. Then I got pregnant, twice, got carried away with bad food decisions and no exercise... no I am double the weight I used to be. I am 4'9" tall, so I am a very short morbidly obese 26 year old!

When my son was 6mo I got pregnant with my daughter. It happened so soon and unexpected to everyone that now when they see me hide behind huge sweatshirts from the old navy plus size section, they joke about me being pregnant again... soon, and unexpectedly. I laugh, not to cry... although I do cry inside, how did it happen? how did I become this? I don't even recognize myself when I look at the mirror, somebody told me on Christmas eve "what's wrong with you? your eyes look sad, you don't only look older, you 'feel' older" I know what's wrong with me, almost 100 pounds that I can't get rid off on my own because it's like I reached the "no return" point. I can't exercise because of excruciating pain on my knees and ankles. I used to climb mountains, I used to swim, roller skate, I used to be a gymnast. Now, I feel like I am a 80 year old woman, and I'm not kidding, my energy is gone along with my joy for life. But you know what? It never hit me before... I was packing on pounds and never noticed, until one day I didn't allow anyone to take pictures of me, and after 8 trips me and my family took this year, we got home and i started seeing pictures of my kids enjoying our vacations... I wasnt in their pictures, it's like ME, their mommy, never existed in any pictures, or in their childhood. Then it hit me... I am wasting precious time, I am wasting the opportunity to create and preserve memories with them. And unconsciously i was avoiding the pictures because of my weight. That's why I started the process for the lap band... Sometimes things like this have to happen in order for us put some value in ourselves, our lives and our bodies. I learned my lesson, now I am on my Quest of being healthy and happy, and also raise 2 healthy and happy kids. I am looking forward to be banded and start my new chapter, and be as healthy as I can be!

I have Tricare Prime, which is run a bit differemtly than Tricare Standard, but I went through something similar. I had initially contacted a local WLS center to see about surgery. I attended a seminar, and got all ready to move forward. Then I learned I needed a referral from my PCM. So I went to the PCM, got my referral, went back to the WLS people, only to find out they don't accept Tricare at all. If I had continued, I'd have had to pay it all out of pocket.

Back to my PCM. After calling around, I found an experienced WL surgeon who accepted Tricare. Got another referral from my PCM to that doctor, and I went to an introductory appointment. He was great, everything looked good, except for the teensy detail nobody had mentioned - his clinic wasn't approved for actually DOING the surgery. They took Tricare, but apparently Tricare hadn't approved them. So, here I go again...

Third try: I found an approved hospital surgery center with an approved doctor, and got a third referral. Went to see them, and had a very frank conversation with their insurance referral coordinator. I wanted to be absolutely clear that everything I needed to be covered WAS covered. And it was.

I was banded three weeks ago, and based on the Claims page at Tricare, it looks like everything the hospital is billing Tricare for is being approved. It'll be interesting to check the bottom line to se how much the hospital bills vs. how much Tricare pays.

Good luck with your journey, and with your surgery.

Dave

Wow! Quite an ordeal! But it was all worth it I see =)

Well, I am going to keep my last dietitian appointment on Monday, and then tell them I found another doctor (on Tricare's page so tricare should be ok with him) and transfer all the paperwork to this new doctor. Hopefully that can be done, and hopefully I won't experience any delay on the process. I definitely don't want to be stuck with bills or copays, so I guess I just have to be more patient. It's been 4 months since I started this process and it feels like an eternity. I am so glad I found this board, now I don't feel so alone and clueless about this! I'll keep y'all posted!

So we all want to meet... that is great!!!

How about after the holidays to get ourselves on check and maybe even set some goals that we can help eachother achieve =)

Can anyone think of a good, quiet location that we can meet at? maybe someplace where they won't kick us out if we chat for too long =)

How does Saturday, January 18th sound? Maybe 10am for a brunch?

Please let me know and send me some suggestions on a location or if you want to change the time and day.

Hope to meet as many of you as possible... I need as much support as I can =)

Hello, I'm new to the boards but I am from Houston! Northwest near Cypress to be exact! Looking forward to meet you all, I am still in the process PRE OP, on Monday I have my last dietitian consultation! I want to be banded asap but I have had some complication choosing doctors that are on Tricare's network. It is being sorted out though, although now the surgery date won't be as close as I thought and wanted to. Nice meeting you all!

Hi,

I think that you and I have run into a similar situation and what I have discovered is that this company is basically ripping off military people. They do not tell you initially that you need to have a referal from a Tricare doctor because they are not within the network to be covered by Tricare.

They are supposed to get preauthorization for all of their procedures before they do them, because that is what they tell you they will do before you come in, but the fact is they do not do this. They submit everything after you have already come in hoping that Tricare will approve it.

As you have stated you are well within the ramification of what is acceptable for this type of surgery so you would do better to just get a Tricare doctor. Do you live in an area where you can use civilian healthcare? I live outside of the limits of where military facilities are accessible so I am authorized to use civilian doctors to be seen as my primary care manager (PCM). Your PCM is the person that will give your the referal so that you can have the authorization to have lapband at no cost to you. I just had all of this done about 2 weeks ago. I have an appointment the first week of next month with a new doctor. I'm not starting over completely, but it has delayed the date of the actual surgery. The bright side to all of this is that I do not have to pay a co-pay and no out of pocket expense.

If you choose to stick with the doctors you are currently with you will have to pay up to the cap and then 50% of whatever Tricare does not cover that is way that it is set up. That is you using your POM rights. So its up to you the way you wish to go, but I would definitely choose free over paying any day. feel free to write me back with any questions and I'll try to respond as best I can. I hope I've helped.

- Dani

Thanks for your post, it was really helpful, I sent you a PM though

You should probably switch doctors NOW to avoid any issues with authorization, coverage, or hefty bills.

There was a mixup at the hospital regarding my insurance coverage, but at one point they had me paying almost $2400 dollars to meet the catastrophic cap ($3000) for Tricare Standard (the catastrophic cap amount depends on if you're considered active duty or "other"). Since I actually have Tricare Reserve Select, my catastrophic cap is $1000 dollars, so I really only owed a little over $600; the hospital finally issued me a refund three months later. Though Tricare covers 100% of the cost, supposedly that only happens after you have paid the deductibles and copays up to the catastrophic cap. I had paid about $400 in deductibles and copays the year of my surgery, so they covered the other $600 up to my catastrophic cap.

However, I have seen a lot of Tricare peeps on here say that they had no out-of-pocket expenses with Standard. I don't know if they already met their caps, or if they had surgery at a military hospital (which I think lowers/eliminates some/all fees?), but according to official Tricare policy, you owe the copay and deductible up to your catastrophic cap.

With that $2400 mixup I had for my surgery, I did a lot of research into Tricare policy--hopefully it helps!

Thank you so much for replying! I called a Tricare approved doctor today and they told me to go to my last dietitian appointment and then tell them I want to transfer to the new doctor. Whew! I already met my catastrophic cap, so hopefully I don't have to pay much!

Hello, I am new to this site, and I have a few questions regarding lap band and Tricare standard.

First, I want to say that I have been in this process for 3 months now, on Monday I have my last dietitian appointment until they submit all the paperwork to Tricare. I am 4’9” and weight 208lbs. I have 2 co-morbidities and I also meet the 200% weight requirement. So I am confident I am going to be approved.

My first question is regarding SWITCHING DOCTORS PRE SURGERY. I didn’t know I had to get a Tricare physician, so I just went to one I found on my own and I have just found out that I might be stuck with self paying the private surgeon. So, can I switch doctors before submitting the paperwork to Tricare? Do I have to start over? Do I change doctors after Tricare approves?

My second question is regarding TRICARE STANDARD COPAYS. I thought lap band surgery was going to be covered 100% Now I have read that I might be paying up to 1,000 out of pocket. Is that true? How much money out of pocket did you have to pay with TRICARE STANDARD.

Thanks in advance! I look forward to meet you all! I really need support while going through this!